Migraine Headaches: Signs, Symptoms, Relation To The Cervical Spine, & Solutions
|Headaches||Migraine Headaches||Tension Headaches||Neck Related Headaches|
|Pain Severity||Mild to Severe||Mild to Moderate||Mild to Moderate – Sometimes Severe|
|Pain Location||Usually One Side||Usually Both Sides||Usually One Side|
What Is A Migraine?
Migraine headaches are a specific type of headache that occurs in 10 percent to 20 percent of the population. The pain of migraine can range from mild to severe and the tendency to get migraine headaches may be inherited, which means a migraine sufferer is likely to have a parent with migraines.
Migraines are twice as common in women as in men with the frequency of headaches varying from one or two migraines per year to several per week. Specialists think that migraine headaches are due to a problem with the biochemical serotonin in which abnormal levels create changes in the brain and blood vessels that lead to migraine headaches.
Migraine pain tends to occur on one side of the head only with nausea and vomiting often accompanying the headaches. Additional symptoms may include weakness in an arm, generalized weakness or fatigue, partial loss of vision, strange smells, diarrhea, and difficulty speaking. The main features are throbbing pain, one sided pain, lasting from 4 to 72 hours, nausea, sensitivity to light, sensitivity to sounds, and made worse by physical activity. Among these features, nausea, worsening with physical activity, and aversion to lights are the most frequent.
- A 2010 cross-sectional study in the journal Migraine was done to determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraines.
It was concluded, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.
- A 2019 study in Cephalalgia recommends osmophobia (fear and/or hypersensitivity to odors) to be included as a factor involved in migraine without aura as a distinguishing factor from other headache types, specifically tension type headaches. The authors recommend inclusion among diagnostic criteria for migraine to increase sensitivity and specificity.
Neck pain is often not recognized as a significant symptom associated with migraine. The article shows that neck pain is more common than nausea in migraine patients. It also emphasizes that this symptom is not mentioned by patients, and doctors do not often ask about it. Neck pain may serve as a warning for impending migraine and may be a better standard by which to gauge severity of migraine and measure treatment.
- A 2022 study in Cephalalgia found neck pain was 12 times more prevalent in migraine patients compared to non-headache patients and twice as prevalent in chronic migraines compared to episodic migraines.
- A 2019 study in the journal Zh Nevrol Psikhiatr Im S S Korsakova found a high prevalence of pain related temporomandibular disorders among chronic migraine sufferers. Almost half of those with chronic migraines reported neck pain immediately before or during headache.
Myofascial pain and tenderness in the masticatory muscles was the most prevalent form of jaw related dysfunction with about 30% experiencing bruxism (clenching jaw or grinding teeth). The authors concluded that myofascial jaw and neck muscle dysfunction are an integral part of chronic migraine pathophysiology which underlies headaches becoming chronic.
- A 2021 study in the Journal of Research in Medical Sciences indicates migraine patients frequently have painful trigger points, especially in the head and neck. They found myofascial release and stretching techniques were effective in improving symptoms.
- A 2023 study in NeuroRehabilitation found trigger point myofascial therapy decreased trapezius muscle stiffness and tone, with alleviation of neck muscle and shoulder girdle pain as well headache relief in episodic migraine patients without aura.
- A 2019 study in Cephalalgia recommends osmophobia (fear hypersensitivity to odors) to be included as a factor involved in migraine without aura as a distinguishing factor from other headache types, specifically tension type headaches. The authors recommend inclusion among diagnostic criteria for migraine to increase sensitivity and specificity.
- A 2020 study in the journal Headache reported individuals with migraine reported lower levels of physical activity even on days in which headache was not experienced, indicating a more global pattern of reduced physical activity.
Migraines are classified into 2 main types. The first, migraine with aura (classic migraine) in which the aura is a warning symptom that begins before the headache, and then fades when the head pain starts. With visual auras, the person sees spots, flickering lights or funny shapes, while other people may experience strange smells, weakness in an arm or leg, dizziness or numbness. The second type is migraine without aura (common migraine). In both migraines with aura and migraine without aura, the patterns of pain are similar.
The goals are to decrease the frequency and severity of headaches (preventative treatment) and to relieve a current headache (symptomatic treatment).
- One important measure is to avoid triggers which can set off migraines in susceptible persons. Some of the possible triggers are psychological stress, exposure to cigarette smoke, certain foods, and birth control pills. According to 1994 study about precipitating factors in migraines: Stress (62%) was the most frequently cited precipitant. Weather changes (43%), missing a meal (40%), and bright sunlight (38%) were also prominent factors. Additionally, spring was cited by 14% of patients as a time for increased migraine attacks, followed by fall (13%), summer (11%), and winter (7%).
Among women with menstrual triggers, migraine headaches most commonly occur during the week before the onset of menses. Migraines during menses are the next most frequent. Less frequent precipitants include lack of sleep, perfume or odors, and weather change.
Specific food triggers include cheese, chocolate, and alcohol. Cheese is the most frequent precipitant. Chocolate is the most specific trigger.
Medications that decrease the frequency of headaches are called preventative or prophylactic medications. Common medications used are Beta-Blockers (Nadolol, Propranolol), calcium channel blockers (Verapamil), Antidepressants (Nortriptyline, Amitriptyline), Ergots (Methylsergide), Nonsteroidal anti-inflammatory drugs, and Anticonvulsives (Valproate, Phenytoin, Clonazepam).
- A 2019 meta analysis of 3646 patients in the journal Plastic & Reconstructive Surgery concluded botulinum type A injections are effective for chronic migraines after 3 months. The authors indicated, “For the first time, a real benefit in patient quality of life is demonstrated with only few and mild adverse events.”
Some people respond to simple symptomatic treatments, such as lying in a dark room, putting an ice bag on the part of the head that hurts, or using over-the-counter pain medications.
Medications taken to stop a headache that has already begun are called symptomatic or abortive medications. One of the major breakthroughs in the symptomatic treatment of migraine is a new class of drugs called triptans, which work by adjusting one of the biochemical abnormalities that can cause migraine. There are now several triptan drugs available as pills, nasal spray or injection.
Nonsteroidal anti-infammatory drugs, NSAIDs, can be very effective for mild or moderate headache. If NSAIDs do not work, an oral nasal spray or injectable triptan is usually tried next. Other drugs for symptomatic treatment include Midrin, ergotamines, or sedatives. Unfortunately, overuse or even daily use of symptomatic medications poses the risk of increasing the frequency of migraine headaches. There are herbs for migraines that may help some.
Migraines are often associated with gastrointestinal symptoms like nausea and vomiting. A symptom that may be associated is gastric stasis, also called gastroparesis , which is delayed emptying of the stomach. This can cause delayed or inconsistency in absorption of oral medications. Therefore, medications that that bypass the gastrointestinal tract like a patch (transdermal), spray or injection may be more effective and consistent therapeutic measures.
- It is thought that means cold therapy is effective in treating a migraine is through cooling of the blood that travels through the vessels in the head. In a 2013 study in the Hawaii Journal of Medicine & Public Health, trials were used for migraine headache sufferers in which a cold neck wrap was applied in the front of the neck targeting the carotid arteries near the surface of the skin.
The frozen neck wrap application at the beginning of a migraine headache resulted in a significant reduction of pain for the participating individuals with migraines. The best results were from 30 minutes of neck cooling using neck wrap at the onset of a migraine headache. The wrap should be capable of applying the ice therapy to the front of the neck.
- A 2018 study in the journal Cephalalgia found that aerobic exercise 3 times per week (bike/cross-trainer/brisk walking for 45 minutes) significantly reduced migraine frequency and burden, pain duration and intensity, neck pain, and increased physical fitness and well being.
- A 2019 study in the Journal of Orthopaedic Sports & Physical Therapy found that women with migraines exhibited decreased neck flexor and extensor muscle endurance. This indicates an association between migraine and inadequate performance of the neck muscles, offering neck exercises as a possible therapeutic and/or preventative measure.
- This was also confirmed in a 2021 study in Clinical Biomechanics where it was found that cervical flexor endurance was reduced in women with chronic and episodic migraine. A good place to start is the deep flexor exercise.
- A 2021 study in BMJ Open found evidence that coenzyme Q10 (CoQ10) appears to have beneficial effects for reduction in the severity, frequency of migraine attacks and duration of headache in adult patients with migraine.
- There has been use of Botulinum toxin in the treatment of chronic migraines. A 2021 study indicates there was a significant reduction in pain medication intake and headache days in the first and second months after injection, and an increase was observed in the third month, indicating a wear-off phenomenon.
Effects On Others
Treatment is essential for not only the sufferer, but others as well. Consider children with a parent suffering from migraine headaches:
- A 2018 study in the journal Headache described impacts on children ages 11 to 17 from living with a parent suffering from migraines. The results indicated over 50% indicated some type of intervention or service to help manage the impact on their lives would be helpful. The main effects were seen in global well being and the parent/child relationship.
- Another 2018 study in the journal Headache assessed the impacts on adolescents ages 13 to 21 years living within a parent suffering migraines on factors like loss of parental support, reverse care giving, interference with school, and missed events and activities. They found rates of moderate to severe anxiety and depression symptoms.